Transcript Signs and symptoms

Introduction to Chemotherapy: A Presentation
for Patients and Families
Welcome and Introduction
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Review

General and specific side effects
 How to manage side effects
 What symptoms to report
 How to report symptoms
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Questions
Tour of Regional Center
Health Care Team
Physicians:
Oncologist,
Family Dr
Patient &
Family
Counsellors
Volunteers
Secretaries
Person living
with cancer
Unit
Clerks
Nurses
Pharmacists
Dieticians
What is cancer?
• Disease that starts in our cells
• Our body’s cells normally grow in an orderly
fashion
• Cancer cells do NOT behave like “normal cells”
 grow to form lumps or tumors
 may spread to other parts of the body
• Cancer is named after the part of the body
where it started
What is chemotherapy?
Chemotherapy …
• Medications that destroy cancer cells
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Also known as “chemo”
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There are over 100 different chemo drugs
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One or more chemo drugs may be used to
treat a cancer.
Goals of chemotherapy
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Eliminate the cancer
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Shrink the tumor
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Prevent cancer from spreading
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Relieve symptoms from cancer, such
as pain
Chemotherapy is given by …
Intravenous
Pills
Take home
Infusion pump
Side effects from chemotherapy
• There are potential side effects for each
specific chemotherapy
• You will NOT experience ALL side effects
• Some side effects can be prevented
Potential side effects
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Bone marrow suppression
Nausea & vomiting
Diarrhea
Constipation
Hair loss
Fatigue
Mouth sores
Reproductive/hormonal changes
Sensory changes
Thinking, memory & attention
changes
Patient resource
“Chemotherapy and Other
Drug Therapies:
A guide for
people with cancer”
Bone marrow suppression
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Blood cells of the bone marrow:
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Red blood cells – carry oxygen to body’s cells
White blood cells –fight infection
Platelets – form blood clots/scabs
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Blood cell levels may decrease following
chemotherapy
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Expected to return to normal by the start of
next treatment
Checking blood cells
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Blood cells must return to a “safe” level prior
to each treatment
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Blood tests are done 1 to 4 days prior to
treatment
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**Check appointment card & lab requisition**
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Blood test results may affect treatment
Low white blood cells
(neutropenia)
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White cells are your infection fighting cells
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May be lowered for a short time after your
chemo treatment
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Your body will be less able to fight infection
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It is important to recognize the signs and
symptoms of an infection
What are some signs of infection?
Signs & symptoms of infection
• FEVER
• Flu like symptoms, e.g. body aches
• Feeling warm, chilled or shaky
• Sore throat and/or mouth
• Productive cough and/or shortness of breath
• Burning when urinating/urinating more often
• Areas of redness or tenderness
• Loose or liquid stools
*Report any signs and symptoms*
If your temperature is 38°C or more
(or 100.4°F or more)…
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This is a FEVER
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Fever is a sign of infection, even if you don’t
have any other signs
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Fever is serious when your white blood cells are
low
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Do not take medications for fever (e.g. Tylenol®)
unless directed by your cancer care team
Report a FEVER IMMEDIATELY!
Numbers to call are in your package
How you can prevent infection
• Wash your hands - frequently with soap &
water
• Avoid people with infections
• Wash your hands
• Check with your oncologist before having
any invasive procedures (e.g. dental or
surgical procedure)
• Avoid skin cuts and nicks
• Wash your hands
Do I come to the clinic if I have
an infection?
Call the Cancer Centre FIRST!
• If you have an infection (flu) or
• If you have been exposed to an infectious
illness such as chicken pox or shingles
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Friends and family with
infections should stay at home
until they have recovered
Low platelets
(thrombocytopenia)
Platelet cells are responsible for making clots
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May be lowered for a short time after your
chemo treatment
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Your ability to form a clot will be lowered
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It is important to recognize the signs and
symptoms of low platelets
What are some signs of low platelets?
Signs & symptoms of low platelets
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cut that won’t stop bleeding
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bruises on body
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bleeding from nose and gums
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red pinpoint rash
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black tarry stools
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blood in urine
*Report any signs and symptoms*
How to manage low platelets
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use soft tooth brush
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continue regular oral hygiene, caution with
flossing
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blow nose gently
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avoid ibuprofen(Advil) & aspirin(ASA),
unless ordered by Doctor
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avoid high risk activities - BE CAREFUL
Low red blood cells
(anemia)
• Red cells are responsible for carrying oxygen to
the body’s cells
• May be lowered for a short time after your
chemo treatment
• Your energy level will be affected
• It is important to recognize the signs and
symptoms of low red cells
What are some signs of low red cells?
Signs & symptoms of low red
blood cells
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Low energy / fatigue
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Shortness of breath
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Chest tightness / chest pain
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Pale appearance
*Report any signs and
symptoms*
Fatigue
• Fatigue is the most common symptom during
and after chemotherapy treatments
Signs/symptoms
• feeling of weariness, tiredness, or lack of energy
that does NOT always improve with rest
• May affect your ability to do daily activities
• Often overlooked, but it is real and can be
managed
How to manage fatigue
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Do regular light exercise
Balance physical and social activities with rest
Listen to your body and rest when needed
Stick to a regular sleep pattern
Eat a well balanced diet
Drink plenty of fluids
Allow friends and family to help you
Talk to your cancer care team if concerned
about fatigue
Resource: Your Bank to Energy Savings “Helping
People with Cancer Handle Fatigue”
Nausea and Vomiting
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Nausea = an unpleasant, queasy
feeling or feeling sick to your
stomach
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Vomiting = throwing up
Not all people receiving chemotherapy
experience nausea and vomiting
Medications to prevent
nausea & vomiting
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Physician will give you a prescription to help
prevent nausea and vomiting
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Fill your prescriptions at your community
pharmacy
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Bring the medications with you
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Unless advised, do not take these pills prior to
coming to your Chemo appointment.
If cost is a concern:
Patient & Family Counseling can assist
How to manage
nausea and vomiting
• Stay well hydrated - 8 cups of fluid
• Eat frequent, small, light meals (esp. on treatment day)
• Keep your mouth clean: brush at least twice daily
Avoid:
• Hot, spicy, greasy foods
• Heavy meals immediately after treatment
• Strong odors
Resource: “Food Choices to Help Control Nausea”
Constipation
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When you are not having bowel movements as
often as you used to
Caused by:
• Some chemotherapy drugs
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Some anti-nausea drugs
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Most pain medications
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Reduced fluid or fiber intake
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Stress
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Lack of exercise
Resource: “Suggestions for Dealing with Constipation”
How to manage constipation
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It is normal to have a bowel movement at least
every 2-3 days (even when little food is eaten)
How to prevent:
• Increase your fluid intake – 8 glasses/day
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Warm fluids
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Increase your fiber intake
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Be as physically active as possible
If you have not had a bowel movement in 3 days
please talk to your cancer care team
Diarrhea
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When your bowel movements are more
frequent or more watery than normal
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Can be serious if not managed
Some causes:
• chemotherapy drugs
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Antibiotics
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bowel surgery
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radiation to the pelvis
How to manage diarrhea
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If prescribed by your oncologist – use your
anti-diarrhea medications as instructed
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Eat small/frequent meals
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Choose foods with less fiber
Avoid:
• foods that may aggravate diarrhea
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spicy/greasy foods
Resources: “Food ideas to help manage Diarrhea” &
“Dietary fiber content of common foods”
Dehydration
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Dehydration can be a result of untreated diarrhea
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can be dangerous if not prevented/managed
How to prevent/manage:
• drink 8 to 10 glasses
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Use “anti-diarrhea” medications - as instructed by
your health care team
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When you feel better, eat foods high in calories
and protein
Diarrhea lasting more than 24 hours - contact your
cancer care team
Signs and symptoms of
dehydration
• Fatigue
• Extreme thirst
• Nausea
• Dry mouth
• Low urine output
• Dark colored urine
*Report any signs and symptoms*
Mouth sores
• Occur within a few days after treatment
• On the tongue, gums, sides of the mouth,
lips and throat
Signs and symptoms:
• Pain
• Bleeding gums
• Difficulty chewing and swallowing
• Can lead to an infection
*Report any signs and symptoms*
How to manage mouth sores
• Inspect mouth regularly
• Practice good oral hygiene
• Rinse 3 to 4 times/day - baking soda in warm
water
• Use a soft toothbrush
• Avoid mouthwash with alcohol
• Make sure dentures fit well
• Avoid extreme hot or cold; spicy foods
Resource: “Food Ideas to Try with Mouth Sores”
Skin changes
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Skin is body’s first line of defense
against bacteria
Signs and symptoms:
• Redness
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rash / acne
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Itching
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peeling
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Dryness
How to manage skin changes
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wash skin often
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warm water and gentle soap
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moisturizers – alcohol/fragrance free
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lanolin based lip balms and creams
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protect against sun exposure (clothing or
SPF 30)
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protective eye wear and hats
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electric razor
Hair loss
• Some chemo drugs
• Begins approx 2-3 weeks after 1st treatment
• Scalp could feel tender when hair starts to fall out
• Some people prefer to cut their hair short
• We suggest not to cut your hair until you come to
your 1st chemo appointment
• Your hair will begin to grow back 3-4 weeks after
final treatment
Resources for hair loss
• “Prescription” for a wig from the oncologist
• Visit a wig shop before you lose your hair
• Donated wigs at Canadian Cancer Society
• Look Good Feel Better Program – register
at your cancer center
Resources:
Information can be found on the BCCA Website
(Coping with Cancer), Volunteer Services and
Patient & Family Counselling
Sensory changes
Senses potentially affected by chemo
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Touch – Muscles and Nerves
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Sound – Hearing
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Taste
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Smell
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Sight
Taste changes
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Foods may not taste the same
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Described as “metallic” or “cardboard” taste
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Can affect your appetite
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Use of sweet and salty flavorings - can help
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Changes are temporary
Resource:
“Coping with Taste Changes” and “Food Ideas to
Cope with Taste and Smell Changes”
Memory changes
• Some memory changes
concentration
“chemo-brain” or “brain fog”
• Difficulty thinking and focusing
• May be caused by chemo, fatigue, stress, insomnia
How to manage memory changes:
• Plan activities
• Make lists
• Ask for help
Resources: BCCA website Coping with Cancer
Reproductive and hormonal
changes
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Chemotherapy may cause changes in hormone
levels or reproductive organs:
 may affect your fertility
 may cause early menopause
 may change your sexual desire
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Talk to your cancer care team for more information
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Talk to Patient and Family Counseling for support
Resources: Sexuality and Cancer
Tips for treatment day
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length of treatments can vary
wear comfortable clothing (sleeves that roll up)
No fragrance – due to sensitivities to smell (this
also applies to support people accompanying you to your
appointments)
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eat a light meal before and after treatment
take your regular medications
Transportation:
• arrange a ride to and from your appointment
Parking:
• BCCA please bring money for the parking meter
…more tips
Bring:
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snacks & drink (no strong odors)
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support persons - 1 person at a time (not appropriate place
for children)
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magazines, books, music with headphones
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New Patient Package
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Questions
Prescriptions:
• our anti-nausea prescriptions are filled in your
community pharmacy
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bring your anti-nausea pills with you
Why do we mention to “drink
plenty of fluids”?
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Water and fluids are vital to health
Staying hydrated helps with:
• Nausea
• Dry mouth
• Diarrhea or Constipation
• Fatigue
• Dry skin
• Easier to start your IV
Natural Health Products (NHPs):
Are they safe during cancer
treatment?
BCCA Recommendations:
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NHPs are NOT recommended during
chemotherapy (radiation and surgical
treatments)
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Please inform your oncologist about the use of
NHP
A Pharmacist is available to counsel and answer
questions
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Safety precautions
• Keep chemotherapy out of reach of children
• It takes approximately 48 hours for your body to
filter the chemo out
• During that time, your body fluids (urine, vomit or
semen) carry small amounts of drug waste
• Exposure to this drug waste can irritate your skin
and be harmful to others & pets
Resource:
“Guidelines for Handling Cancer Drugs and Body
Fluids in the Home”
…more precautions
• Flushing toilet - lid down to prevent splashing
• If chemotherapy or body wastes splash on
your skin - wash the area with soap and
water
• Use a condom during intercourse
• Pregnancy and breast feeding should be
avoided
Resources:
“Chemotherapy and other Drug Therapies” &
“Sexuality and Cancer”
When to call?
CALL if you have problems such as:
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Fevers (≥ 38°C) and/or shaking, chills
Mouth sores, mouth pain
Uncontrolled nausea or vomiting
Uncontrolled diarrhea
Constipation
Abnormal bleeding or bruising
Painful IV site
…and if you are not sure…
CALL:
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Telephone Nursing Line during clinic hours
On-call Doctor after clinic hours
Pharmacy Services
Drug
Information
Natural Health
Products
Side
Effects
Drug
Interactions
Identification required for
medication pick up
 Patient ID required for every prescription
Two identifiers each time – eg. birth date, address
 One primary piece of ID
 eg. Driver’s license, BC provincial identity card, passport
 Or two pieces of secondary ID
 eg. BCCA identification card, BC Care Card, birth certificate
 When pick up by person other than patient
 Letter signed by patient indicating permission
 Or two pieces of patient’s ID as indicated above
Patient and Family
Counselling Services
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Support and counselling are a vital part of coping
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Individuals, couples and families
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Support groups and programs
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Information and referral to community services
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Assistance and information about practical and financial
concerns
Resources:
http://www.bccancer.bc.ca/PPI/copingwithcancer/default.htm
Nutrition Services
• Oncology Dietitian available at each Cancer Center
• Able to support you with difficulty eating, drinking,
swallowing or maintaining your weight
• Ask your nurse or doctor for referral
Resources:
BCCA Website - Coping with Cancer
 Nutritional Support: BC Cancer Agency
Health Link BC (formerly Dial-A-Dietitian)
 Dial 8-1-1 for general nutrition questions or
Speak with a specialized Oncology Dietitian
Resource: “Eating Well When You Have Cancer”
Library Services
• Librarian available at each Cancer Center
Resources:
• Books, pamphlets, audio and videotapes
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Cancer, treatment, coping with cancer, care-giving,
healing, relaxation, sexuality and other topics of
interest
QUESTIONS?